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E2231. An Eye-opening Experience: Review of Orbital Trauma
Authors
  1. Jason Kim; Brooke Army Medical Center
  2. Michael Povlow; Brooke Army Medical Center
  3. Sara Clayton; Brooke Army Medical Center
Background
According to the World Health Organization Blindness Data Bank, about 55 million patients worldwide present with ocular injuries each year resulting in 23 million individuals with visual impairment and 750,000 hospitalizations. The prevalence of trauma-related eye injuries is estimated to be between 2-6% with ocular involvement in as much as 84% of patients with head injuries. Traumatic mechanisms range from motor vehicle collisions to penetrating foreign bodies. Given the substantial risk of visual impairment in the setting traumatic injury, radiologists play an integral role in the initial evaluation of orbital injuries to prompt emergent ophthalmologic assessment and appropriate management.

Educational Goals / Teaching Points
The purpose of this exhibit is to review the imaging manifestations of orbital trauma in the acute setting and key findings that can help guide the ordering clinician. We will discuss the normal ocular and periocular anatomy and appearance on imaging. The spectrum of various patterns of orbital and ocular injury will be demonstrated through an anatomically based approach to include the bony orbit, globe, orbital compartments, and neurovascular structures. Pathology to be reviewed include lens dislocation, retinal and choroidal hemorrhage, globe rupture, penetrating foreign bodies, traumatic optic neuropathy, traumatic carotid cavernous fistula, orbital wall fractures and orbital compartment syndrome, among others.

Key Anatomic/Physiologic Issues and Imaging Findings/Techniques
A systematic, anatomically based approach is useful in evaluating the orbital contents, especially in the setting of polytrauma. The bony orbit should be closely evaluated for fractures and associated changes in orbital volume and involvement of the orbital apex. The anterior chamber and lens should be scrutinized for displacement, indicative of corneal laceration or lens dislocation. Globe injuries may demonstrate hemorrhage in the posterior segment, retinal detachment or penetrating foreign bodies. Stranding or abnormality of the extraconal or intraconal fat can be helpful to identify subtle injuries. Finally, the optic nerve complex should be assessed throughout its course for transection or local mass effect by adjacent structures.

Conclusion
Traumatic orbital injuries remain a significant etiology for visual impairment or blindness worldwide. Radiologists play a key role in the initial evaluation of orbital injuries and guiding ophthalmologic assessment in the acute traumatic setting.